Academic Medicine最新文献

{"title":"Medical Education in the Context of War in Ukraine.","authors":"Bohdan O Koshak, Svitlana I Smiyan, Anastasia V Bilukha","doi":"10.1097/ACM.0000000000005956","DOIUrl":"10.1097/ACM.0000000000005956","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"407"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Does the Novice Become the Expert? An Instrumental Case Study of Procedural Educators.","authors":"Ilana Roberts Krumm, Adrienne Strait, Lekshmi Santhosh","doi":"10.1097/ACM.0000000000005917","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005917","url":null,"abstract":"<p><strong>Purpose: </strong>The classic paradigm of procedural education in medical training has involved trainees learning and performing invasive bedside procedures and subsequently teaching these procedures to more junior trainees. Many existing resident-as-teacher curricula focus on cognitive domains; there has been a lack of literature examining the transition from learner to teacher in procedural education. This hypothesis-generating instrumental case study explored how expert procedural educators transitioned from novice procedural educators to experts.</p><p><strong>Method: </strong>A constructivist approach with semistructured interviews was used to explore the individual narratives and experiences of faculty of the Hospitalist Procedure Service at the University of California San Francisco as they reflected on their journey from learners to teachers, focusing on the faculty of the hospitalist procedure team at the University of California San Francisco. All 12 Hospitalist Procedure Service faculty members received invitations to be interviewed, and 9 agreed to participate. Interviews were conducted between July and October 2023.</p><p><strong>Results: </strong>The 9 interviews created a rich and complex picture of the individual experiences and perceptions of procedural teaching. The faculty members varied in experience, ranging from 2 years on the procedure service faculty to more than 15 years of experience. Four main themes emerged from the interviews: methods for building teaching skills, tools that facilitate further educator growth, essential behaviors of effective educators, and common challenges. Inductive thematic analysis revealed trial and error as a major means of building procedural pedagogy and the use of precise communication as a crucial skill to manage learner cognitive load and the emotional challenges associated with learning and teaching procedures.</p><p><strong>Conclusions: </strong>The use of precise communication as a tool for both educator and learner to navigate the complexities of procedural teaching highlights the essential role of clear instruction and feedback in the learning process.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"453-458"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training Health Professionals to Prevent Heat-Related Illness at Work.","authors":"Eric Persaud","doi":"10.1097/ACM.0000000000005947","DOIUrl":"10.1097/ACM.0000000000005947","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"408-409"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial Barriers to Rural Graduate Medical Education: Medicare Funding Methods for Sole Community and Medicare-Dependent Hospitals.","authors":"Mukesh Adhikari, Emily M Hawes, Jacob Rains, Christopher L Francazio, George M Holmes","doi":"10.1097/ACM.0000000000005948","DOIUrl":"10.1097/ACM.0000000000005948","url":null,"abstract":"<p><strong>Purpose: </strong>Policymakers are exploring options to address rural-urban physician maldistribution, including reducing rural residency training barriers. This study estimated Medicare graduate medical education (GME) reimbursement that sole community hospitals (SCHs) and Medicare-dependent hospitals (MDHs) are disqualified from receiving compared with hospitals under the Prospective Payment System (PPS) and calculated the GME reimbursement per resident for MDHs and SCHs under different scenarios.</p><p><strong>Method: </strong>This simulation study used Healthcare Cost Report Information System data on hospitals that had been SCHs or MDHs between 2011 and 2021 and did not have any resident full-time equivalents (FTEs) in the most recent year. Reimbursements were calculated under the PPS and hospital-specific rate (HSR), assuming all other hospital financing elements remained unchanged, apart from adding resident FTEs.</p><p><strong>Results: </strong>A total of 242 hospitals were identified as current or recent SCHs or MDHs with an average daily census of 25 or more and no residents in their most recent cost reports; 139 (57.4%) were paid under the HSR. The median (interquartile range) reimbursement per resident was $179,442 ($153,078-$208,412) under PPS and $107,294 ($85,134-$128,259) under HSR, a difference of nearly $70,000 per resident. The median opportunity cost per FTE was approximately $73,000 for SCHs and approximately $65,000 for MDHs. No significant per-resident differences were observed in the GME payments based on program size. Due to higher GME payments from PPS vs HSR, the number of hospitals defaulting to HSR decreased, and by the end of the third year of the program, more than 10% hospitals switched from HSR to PPS.</p><p><strong>Conclusions: </strong>Under the current health care and GME reimbursement method, SCHs and MDHs face considerable financial barriers to launching or participating in GME programs. Policy adjustments to address this barrier may incentivize more rural facilities to launch or participate in GME, potentially mitigating the geographic maldistribution of physicians.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"490-496"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stimulating Medical Student Professional Identity Formation Through Mentored Longitudinal Partnerships With Patient Teachers.","authors":"Lydia Busey, Natalie May, James R Martindale, Elizabeth B Bradley, Margaret Plews-Ogan, Rachel H Kon","doi":"10.1097/ACM.0000000000005960","DOIUrl":"10.1097/ACM.0000000000005960","url":null,"abstract":"<p><strong>Problem: </strong>Longitudinal patient relationships can positively affect medical students' professional identity formation (PIF), understanding of illness, and socialization within medical practice, but a longitudinal integrated clerkship (LIC) model is not always feasible. The authors describe the novel Patient Student Partnership (PSP) program, which provides authentic roles for students in mentored longitudinal patient relationships while maintaining a traditional block clerkship model.</p><p><strong>Approach: </strong>The PSP program at the University of Virginia School of Medicine pairs all matriculating medical students with a patient living with chronic illness to follow across multiple health care settings until graduation. The 4-year required program is rooted in the conceptual frameworks of PIF, experiential learning, and communities of practice. This program evaluation used survey data collected from the first full cohort of students (Class of 2022) at 5 timepoints during the initial 4 years of implementation (2018-2022).</p><p><strong>Outcomes: </strong>At graduation, 152 students had completed the PSP program. Students' narrative responses on surveys indicated PSP participation helped them connect classroom learning to clinical practice, play meaningful roles in patient care, practice communication skills via electronic health records, and practice self-reflection about their future roles as physicians. On the survey administered as students approached graduation, 54/67 (80.6%) of responding students agreed or strongly agreed that the PSP program allowed them to observe the general trajectory of a patient's chronic illness and its impact on daily life.</p><p><strong>Next steps: </strong>This initial evaluation demonstrates the feasibility of integrating a mentored longitudinal experience into an existing block curriculum. Future study of PIF development occurring during PSP activities is needed to explore whether the PSP program stimulates PIF in ways similar to LICs. Additionally, the authors plan to address variability in engagement between medical students and their patient teachers through further student and faculty development regarding role clarification.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":"428-432"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Typology for Rural Residency Training.","authors":"Randall Longenecker, Darin Bell, Davis G Patterson","doi":"10.1097/ACM.0000000000005932","DOIUrl":"https://doi.org/10.1097/ACM.0000000000005932","url":null,"abstract":"<p><p>Until rural track program definitions were recently established in regulation and accreditation,1 there was no widely accepted classification system for rural graduate medical education (GME), making it difficult to conduct educational research, compare published results, or navigate the maze of options available to residency applicants. This typology for rural residency training, refined in use by rural medical educators, student applicants, and researchers2,3 over the past 2 decades, addresses varying degrees of required rurally located training, rural focus, and rural graduate placement outcomes. Acknowledging the range and differences across rural and frontier communities, this typology considers to be rural a geographic location that is rural by any 2 of the more than 75 federal definitions that exist (e.g., Core-Based Statistical Areas, Rural-Urban Commuting Area codes). For 8 common federal definitions, see RHIhub's \"Am I Rural?\" Tool at https://www.ruralhealthinfo.org/am-i-rural.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":"100 4","pages":"524"},"PeriodicalIF":5.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Shame Shaped Me: Exploring the Impact of Shame on Professional Identity Formation in Medical Trainees.","authors":"Gayle Haischer-Rollo, Holly Meyer, K Christopher McMains, Lara Varpio, William E Bynum","doi":"10.1097/ACM.0000000000006048","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006048","url":null,"abstract":"<p><strong>Purpose: </strong>In medical education, the influence of shame is largely absent from current conceptualizations of professional identity formation (PIF), even though this process is susceptible to the effects of shame experiences. This study endeavors to examine how shame influences PIF among medical learners.</p><p><strong>Method: </strong>Adopting a constructivist approach and hermeneutic phenomenology, the authors interviewed 9 final-year graduate medical trainees at 2 U.S. military medical centers between September 2022 and February 2023. The authors used a semistructured interview guide and photo-elicitation to deeply explore participants' shame experiences and how these influenced participants' PIF. Data analysis focused on understanding the lived experiences of these events and their impact on PIF, yielding themes central to the phenomenon of shame-induced PIF that helped characterize its deeper meaning.</p><p><strong>Results: </strong>Participants described shame events triggered by incidents like board exam failure, patient care mistakes, and needing educational remediation. Analyzing the influence of these events on PIF revealed 2 processes that helped propel identity arcs toward-and sometimes away from-an ideal version of the self: identity disruption and identity work. Identity disruption led to a distancing from the community and could lead to isolation, anxiety, and impaired belonging. These feelings of disruption often led to significant identity work, which involved modifying self-talk, leveraging agency, and engaging in identity negotiation (often in service of growth toward a modified professional identity).</p><p><strong>Conclusions: </strong>This study uncovers the potential for shame to serve as a catalyst for meaningful identity work in medical trainees. The findings expand on existing conceptualizations of PIF by highlighting that it is a dynamic, ongoing, nonlinear, and multidimensional process. The analysis points to actions educators and learners can take to support learners' constructive navigation of shame experiences and their impact on PIF.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Women Physicians in Academic Medicine: A Scoping Review.","authors":"Neha J Purkey, Peggy Han, Amanda Woodward, Alexis S Davis, Lindsay Johnston, Robin Klein, Catherine D Krawczeski, Kristen T Leeman, Kerri Z Machut, Meghna D Patel, Melissa Scala, Mary E McBride","doi":"10.1097/ACM.0000000000006052","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006052","url":null,"abstract":"<p><strong>Purpose: </strong>Multiple studies have described higher rates of attrition for women in academic medicine, but actionable strategies to retain women in the field have not been well studied in the current era. This study reviewed the existing literature for studied interventions to support the advancement of women physicians in academic medicine.</p><p><strong>Method: </strong>A scoping review was conducted by searching the PubMed, Embase, and Scopus databases for articles describing interventions intended to support women physicians on September 12, 2022, and updated on August 23, 2024. All articles from inception of the databases through the search dates were included. Search terms included female physician, mentoring, leadership, career development, job satisfaction, advancement, and synonyms. Articles related to inequities in patient care, interventions related to nonphysician health care workers, and studies describing sexism without measured solutions were excluded from the analysis. Kirkpatrick's framework for the evaluation of educational programs was used to further classify results by 4 levels of evaluation for an educational or training program: reaction, learning, behavior, and results.</p><p><strong>Results: </strong>A total of 2,813 articles underwent abstract screening and full-text review, with 64 articles included in the final analysis. Seven studies (10.9%) were randomized controlled trials. Only 2 studies (3.1%) specifically examined mid- or late-career women. Career development programs (15 [23.4%]), mentorship programs (10 [15.6%]), and women's interest groups (7 [10.9%]) were the most described interventions. Outcome measures were most commonly satisfaction with the intervention (22 [34.4%]), self-perceived improvement in skills (17 [26.6%]), and representation or recruitment of women into a field (12 [18.8%]).</p><p><strong>Conclusions: </strong>This study describes 64 articles of studied interventions to support the advancement of women in medicine. Additional studies are needed and should emphasize rigorous study methods, a focus on institutional solutions, and identifying and targeting the needs of women physicians beyond their early career.</p>","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Snooze Control: Evidence-Based Strategies for Mastering Sleep on Night Shifts.","authors":"Brendan Freeman, Anand Swaminathan, Abbas Husain","doi":"10.1097/ACM.0000000000006051","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006051","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming the Ecosystem of Medical Education: Community-Engaged Medical Education (CEME).","authors":"Carmela Rocchetti, Christopher Duffy, Robin O Winter, Miriam Hoffman","doi":"10.1097/ACM.0000000000006050","DOIUrl":"https://doi.org/10.1097/ACM.0000000000006050","url":null,"abstract":"","PeriodicalId":50929,"journal":{"name":"Academic Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}